Efficacy and toxicity of old and new disease modifying antirheumatic drugs
Peter Tugwella, Vivian Welchb, Maria Suarez-Almazord, Beverley Sheab, George Wellsca Department of
Medicine, Ottawa Hospital
General Campus, LM-12, 501 Smyth Road,
Ottawa, Ontario, Canada K1H 8L6, b Clinical Epidemiology Unit, Loeb Health Research
Institute, F6, c Epidemiology and Community Medicine, University
of Ottawa, d Health
Services Research, Baylor College of Medicine, Veteran Affairs Medical
Center
Correspondence to: Dr Tugwell
| The first 150 words of the full text of this article appear below. |
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Introduction |
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The goal of disease modifying antirheumatic drug (DMARD) treatment is "to induce remission and maintain control of inflammatory joint disease".1 Disease modification has been recommended by Edmonds2 to focus on two components, firstly reduction in the structural damage shown by imaging techniques, and secondly improvement/maintenance of health status in association with decreased inflammatory synovitis. The optimal management of patients with rheumatoid arthritis requires the integration of art and evidence-based science to make a clinical judgement. The evidence-based component needs to incorporate the evidence on four aspects: (a) seriousness of the outcomes; (b) evidence for effectiveness and magnitude of treatment effect; (c) risk of adverse effects; and (d) cost effectiveness of treatment.
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Seriousness of the outcomes |
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This affects many aspects as reflected in the "7Ds"
listed in figure 1. The impact has often been underestimated, but
recent evidence of the increased mortality, the substantial
discomforts, psychosocial dysfunction, or physical disability and the
costs incurred
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